World class expertise, patient care and treatment Here at Coriel Orthopaedic Group, we work hard to treat those that need us most. From broken bones to arthritis, damaged tendons to joint pain and replacement, we can do it all. People spend hours searching the internet for the magical treatment that is meant to miraculously help them recover from such injuries. But the truth is, they really need to be visiting medical professionals. Luckily we have an incredible group of specialist private orthopaedic surgeons in Rotherham that can help treat them and you! All about Orthopaedics… Orthopaedics is a branch of medicine that focuses on the care of the musculoskeletal system. This system is made up of muscles, bones and joints, as well as ligaments, and tendons. The study of orthopaedics is truly fascinating and it offers doctors the opportunity to treat patients with conditions that are affecting the muscles and bones, allowing patients to live fuller and more mobile lives. A person who specialises in orthopaedics is known as an orthopaedist or orthopaedic surgeon. On average an Orthopaedic surgeon does a 5 year degree in medicine (recognised by the General Medical Council), a 2 year foundation programme of general training, 2 years of core surgical training in a hospital and up to 6 years of specialist training. These surgeons are devoted to the prevention, diagnosis, and treatment of disorders of the bones, joints, ligaments, tendons and muscles. Some orthopaedists are generalists, while others specialise in certain areas of the body, such as: Hand and Wrist Shoulder and Elbow Knee Hip and Groin Foot and Ankle Here at Coriel Orthopaedic Group our surgeons have over 100+ years of combined experience ensuring that we provide our patients with world class expertise, patient care and treatment. Specialist Orthopaedic Surgeons Can Treat… Orthopaedic surgeons can treat a wide variety of musculoskeletal conditions and will explore both nonsurgical and surgical treatment options, depending on the severity of the condition and the amount of pain that it is causing. Whether these conditions have been present since birth, have occurred as a result of injury or are age-related, and orthopaedist will work hard to understand and treat the condition accordingly. Many people know that orthopaedic surgeons treat broken bones, and replace painful joints, but did you know that orthopaedic surgeons also treat patients for: Sports injuries Shoulder dislocation Tennis Elbow Carpal tunnel and hand injuries Back pain, ruptured disks and spinal stenosis Flat feet and hip dysplasia Achilles tendon injuries, bunions and foot/ankle injuries Osteoporosis Arthritis What happens in an appointment? Not sure what to expect in an appointment? Here is a little more information. One of our Orthopaedic surgeons will work to diagnose the condition of the patient. This normally includes conducting a physical examination and possible taking X-rays if there is a need to do so. Sometimes, we will need to use other methods such as an injection, to help make the diagnosis or treat the condition, additional testing may also be necessary to confirm the diagnosis. Diagnosis In order to help diagnose a patient’s condition, the surgeon will: carry out a physical examination ask about the patients symptoms review their medical record to gather more information about their medical history and overall health review any X-rays conducted before the appointment The orthopaedist may also order additional diagnostic tests is necessary such as: an MRI scan a bone scan an ultrasound blood tests nerve conduction studies Our surgeons will work alongside you and your GP to provide the best possible treatment and patient care. Therefore if you are looking for specialist orthopaedic surgeons in Rotherham that can help treat you simply contact us. We look forward to helping you get back to doing the things that you love. Book Treatment Other healthcare providers in Rotherham Knowing the healthcare providers in your area is extremely useful and in fact essential. Here are some of Rotherham’s most trusted professionals: Rotherham Chiropractic Clinic Rotherham General Hospital #privatesurgeonsrotherham #corielorthopaedic #privatesurgeons #rotherham #physiotherapy #surgeons #orthopaedic #specialistsurgeons

Getting you back to doing the things you love… We all know someone that has been affected by bone, muscle or joint pain, that someone might even be ourselves! Whether its arthritis, a sprained ankle or knee pain, we have all searched the internet for the magical treatment that is meant to miraculously help us, but the truth is, we need to be visiting real specialists for these kinds of injuries and conditions. Luckily, we have an orthopaedic surgery in Doncaster that can help treat us. How our Orthopaedic Surgeons can help you Orthopaedics is a branch of medicine that focuses on the care of the musculoskeletal system. This system is made up of bones, joints and muscles as well as ligaments, and tendons. The study of orthopaedics is truly fascinating and it offers doctors the opportunity to treat patients with conditions that are affecting the muscles and bones, allowing patients to live fuller and more mobile lives. Here at Coriel Orthopaedic group we are improving the lives of people in Doncaster by doing just this. A person who specialises in orthopaedics is known as an orthopaedic surgeon. On average an Orthopaedic surgeon does a 5 year degree in medicine (recognised by the General Medical Council), a 2 year foundation programme of general training, 2 years of core surgical training in a hospital and up to 6 years of specialist training. These surgeons are devoted to the prevention, diagnosis, and treatment of disorders of the bones, joints, ligaments, tendons and muscles. Some orthopaedists are generalists, while others specialise in certain areas of the body, such as: Hip and Groin Foot and Ankle Hand and Wrist Shoulder and Elbow Knee Read more about our consultants to find out how they can help you. What can an Orthopaedic Surgeon Treat? Orthopaedic surgeons can treat a wide variety of musculoskeletal conditions and will explore both nonsurgical and surgical treatment options, depending on the severity of the condition and the amount of pain that it is causing. Whether these conditions have been present since birth, have occurred as a result of injury or are age-related, and orthopaedist will work hard to understand and treat the condition accordingly. Many people know that orthopaedic surgeons treat broken bones, and replace painful joints, but did you know that orthopaedic surgeons also treat patients for: Back pain, ruptured disks and spinal stenosis Flat feet and hip dysplasia Achilles tendon injuries, bunions and foot/ankle injuries Osteoporosis Arthritis Sports injuries Shoulder dislocation Tennis Elbow Carpal tunnel and hand injuries What appointments are made of… Getting Orthopaedic help is not something to be nervous about. Our Orthopaedic Surgery in Doncaster is run by some of the UK’s most highly trained surgeons that have over 100+ years of combined experience ensuring that we provide our patients with world class expertise, patient care and treatment. During your appointment one of our Orthopaedic surgeons will work to diagnose the condition that you may be facing. This normally includes a conversation with the patient, a physical examination and possibly taking X-rays if there is a need to do so. At times we will need to use other methods such as an injection, to help make the diagnosis or treat the condition, additional testing may also be necessary to confirm the diagnosis. In order to help diagnose a patient’s condition, our surgeon will: do a physical examination ask about symptoms review medical records and overall health review any X-rays conducted before the appointment The orthopaedist may also order additional diagnostic tests is necessary such as: an MRI scan a bone scan blood tests Our surgeons will work alongside you and your GP to provide the best possible treatment and patient care. Therefore if you are looking to book an appointment at an orthopaedic surgery in Doncaster then simply contact us. Book Treatment #orthopaedicsurgeons #orthopaedics #doncaster #privatesurgeons #surgeonsindoncaster #privatesurgeonsdoncaster

O is for Orthopaedics Have you been affected by bone, muscle or joint pain? Whether its arthritis, a sprained ankle or knee pain, most of us have searched the internet for the magical treatment that is meant to miraculously help us, but the truth is, we need to be visiting real specialists for these kinds of injuries and conditions. Luckily we have specialist surgeons in Worksop that can help treat our orthopaedic needs. Orthopaedics is a branch of medicine that focuses on the care of the musculoskeletal system. This system is made up of muscles, bones and joints, as well as ligaments, and tendons. The study of orthopaedics is truly fascinating and it offers doctors the opportunity to treat patients with conditions that are affecting the muscles and bones, allowing patients to live fuller and more mobile lives. Here at Coriel Orthopaedic Group our surgeons have over 100+ years of combined experience ensuring that we provide our patients with world-class expertise, patient care and treatment. A person who specialises in orthopaedics is known as an orthopaedist or orthopaedic surgeon. On average, an Orthopaedic surgeon does a 5 year degree in medicine (recognised by the General Medical Council), a 2 year foundation programme of general training, 2 years of core surgical training in a hospital and up to 6 years of specialist training. These surgeons are devoted to the prevention, diagnosis, and treatment of disorders of the bones, joints, ligaments, tendons and muscles. Some orthopaedists are generalists, while others specialise in certain areas of the body, such as: Hip and Groin Foot and Ankle Hand and Wrist Shoulder and Elbow Knee How our Orthopaedists in Worksop can help you Orthopaedic surgeons can treat a wide variety of musculoskeletal conditions and will explore both nonsurgical and surgical treatment options, depending on the severity of the condition and the amount of pain that it is causing. Whether these conditions have been present since birth, have occurred as a result of injury or are age-related, and orthopaedist will work hard to understand and treat the condition accordingly. Many people know that orthopaedic surgeons treat broken bones, and replace painful joints, but did you know that orthopaedic surgeons also treat patients for: Sports injuries Shoulder dislocation Tennis Elbow Achilles tendon injuries, bunions and foot/ankle injuries Osteoporosis Arthritis Carpal tunnel and hand injuries Back pain, ruptured disks and spinal stenosis Flat feet and hip dysplasia Appointments in Worksop… Not sure what to expect in an appointment? Here is a little more information. One of our Orthopaedic surgeons will work to diagnose the condition of the patient. This normally includes conducting a physical examination and possible taking X-rays if there is a need to do so. Sometimes, we will need to use other methods such as an injection, to help make the diagnosis or treat the condition, additional testing may also be necessary to confirm the diagnosis. How we diagnose conditions In order to help diagnose a patient’s condition, our surgeon will firstly have a conversation with the patient regarding their symptoms and level of pain or discomfort. Following this they will carry out a physical examination which may lead to X-Rays and possible further tests such as bone scans. Our surgeons will be with you every step of the way to ensure that you get the medical treatment that you need, as well as personal patient care and support. We will work alongside you and your GP to provide the best possible treatment and patient care, helping you get back to doing the things you love. Therefore if you are looking for specialist private surgeons in Worksop that can help treat your orthopaedic needs, simply contact us. Book Treatment Other important healthcare providers in your area Worksop Physiotherapy Worksop Pharmacy Bassetlaw District General Hospital #worksop #orthopaedicsurgeons #orthopaedics #specialists #unitedkingdom #specialistsurgeons

Welcome to the Footnotes newsletter, I hope you find it useful. My name is Antony N Wilkinson (MSc, FCPodS, FFPM RCPS (Glasg), I am a Consultant Podiatric Surgeon and my aim is to provide you with useful information, contact details, referral options for foot and ankle problems to improve patient care. Each newsletter will focus on a specific condition, containing information you may find useful in your clinical practice. I have practiced in Doncaster for 22 years, treating a wide range of foot pathology. I offer treatments from orthotic management through to surgical reconstruction of the foot and ankle. Focus on Hallux valgus What is it? Hallux valgus is a common condition affecting the big toe joint. It is associated with splaying of the first metatarsal away from the second metatarsal causing an increase in the intermetatarsal angle, whilst a drift of the big toe towards the second increases the hallux valgus angle. The normal range for these angles are: IM angle 8-12 degrees HV angle 0-15 degrees Patients usually complain of increased joint pain with shoe pressure over the medial bump, which in some cases form a bursa (bunion). Although there may be some osteoarthritis within the joint, this is usually mild. How do I examine the joint? The first and most important thing to do is to ask the patient to stand barefoot. The foot can dramatically change shape and position on weight bearing, as contact with the ground splays the forefoot and often everts the hindfoot. This is why requesting weight bearing X-rays is so important. With the patient non weight bearing, check the range and quality of the joint motion. Does it feel stiff? Is that stiffness associated with grating of the joint? If so there is a good chance the joint is arthritic. What treatment should I suggest? NHS patients need to meet certain CCG commissioning guidelines. A: Significant and persistent pain when walking AND conservative measures tried for at least 6 months Most patients have discomfort with footwear restriction rather that acute pain, which is often seen more in osteoarthritis. In my practice the average pain score using a validated tool pre-op is 58/100 in 1754 patients. Most patients who request surgery therefore would score around 5-6/10 on a visual analogue scale. There is no evidence that conservative treatments will correct the condition, however wide fitting sensible shoes, padding may reduce symptoms. B: Ulcer development Ulcer development is uncommon, may be an issue in diabetics or frail patients and requires urgent attention. C: Evidence of severe deformity, overlapping toes Once the hallux valgus encroaches the second toe, structural changes occur, leading to development of hammer toe, pain in the ball of the foot and midfoot osteoarthritis. Surgery is the best option in these cases. D: Physical exam and X-ray show degenerative changes in the joint, increased intermetatarsal angle or valgus deformity greater than 15 degrees. If the joint has degeneration it is more likely to be Hallux rigidus which is often confused with hallux valgus due to the bony exostosis that grows around the joint. It is difficult in primary care to evaluate X-ray as usually only the report is seen. Asking the radiologist to measure the angles on X-ray when requesting the film will help you in the referral process. Alternatively stand the patient barefoot on a sheet of paper. Place a ruler along the metatarsal and draw a line, repeat along the big toe and intersect the lines. Measure with a protractor. Remember: Private patients do not need to meet this criteria. What can be done to treat the condition? Surgery involves re-aligning the metatarsal and reducing both the IM angle and HV angle to normal. The vast majority of procedures are carried out under local anaesthetic. Many different ways of doing this have been documented. The choice of operation depends on the severity of the deformity, however all procedures have around a six week recovery period. Modern fixation techniques allow a patient to return to trainers at 2 weeks and shoes by 6-8 weeks. What are the risks? Short term risks include; infection, swelling and DVT which is rare. Initial elevation of the limb in the first 2 weeks reduces swelling significantly. Long term risks such as joint pain/stiffness and footwear restriction is also rare and can be improved by early mobilisation of the treated joint. How effective is the surgery? In an audit of 1818 patients from my practice: 94.2% were better following surgery 2.6% were the same 2.1% a little worse 0.8% deteriorated What tests should I request? X-rays are the best imaging modality to request. Standard views Dorso-plantar (DP) weight bearing – This view provides the best evaluation of the deformity and is used to measure IM and HV angles. Lateral view weightbearing – This view provides information about the alignment of the hindfoot which may be affected by the condition Medial oblique (MO) – This view provides information about the joint spaces, the lesser metatarsophalangeal and metatarso-cuneifom joints. Especially when evaluating osteoarthritis. Useful Websites to direct patients to: Bunions https://www.nhs.uk/conditions/bunions/ Silicone Pads and Splints https://www.silipos.com Bunion Splints www.amazon.co.uk/Best-Sellers-Health-Personal-Care-Bunion-Splints/zgbs/drugstore/2826221031 #footnotes #coriel #training #doncaster #corielorthopaedic #halluxvalgus #blog #orthopaedic #footandankleproblems #paediatrictraining

What is Hip Arthritis? Arthritis of the hip is a condition in which the cartilage of the hip joint thins or wears away with time. The hip joint is made up of a ball (femoral head) and socket (acetabulum). The cartilage is a protective surface which allows the bones of the hip joint to move smoothly against each other. When the cartilage wears away, the bone rubs against the bone, which can be an extremely painful condition. Hip arthritis presents with pain in the groin approximately 90% of the time. In 10% of patients, pain may be isolated to the side of the hip, buttock or knee. Arthritis of the hip is unfortunately a progressive problem, although the rate of progression is variable. How is Hip Arthritis Diagnosed? The diagnosis of hip arthritis is made in combination with a history of pain localized to the hip area, a clinical examination which reproduces pain with movement of the hip, and x-ray findings showing narrowing of the joint space between the ball and socket Figure 1: Osteoarthritis of the left hip On occasion where there is doubt regarding the source of one’s pain, a “diagnostic” injection of local anaesthetic into the hip joint may be performed. If this injection alleviates the patient’s pain, then it is highly likely that the hip is the cause of the symptoms. Options for Treatment Non-surgical: All patients should attempt non-surgical treatments initially. These consist of medications, exercises (in the form of physiotherapy), weight loss (if applicable), activity modification, and hip injections. Medications may be helpful in managing degenerative arthritis, although no medications currently exists that can reverse the process of osteoarthritis. For degenerative arthritis, anti-inflammatory medications (NSAIDS) may be helpful for the management of symptoms. Injections into the hip of steroid (cortisone) or lubricants (hyaluronic acid) are typically performed using X-ray guidance under local anaesthetic. Whilst useful as a short-term option for pain control, they seldom provide long-term benefit and therefore are not commonly a long-term solution. Surgical: Those patients who still have significant pain, (e.g., pain that inhibits them in their daily activities or keeps them awake at night) following attempts at non-surgical treatment, would be recommended for total hip replacement surgery. Traditional hip replacement surgery involves making an incision on the side of the hip (lateral approach) or the back of the hip (posterior approach). Both techniques involve detachment of muscles and tendons from the hip in order to replace the joint. Detachment of these muscles may result in increased pain after surgery, and may prolong the time to fully recover. Failure of these muscles to heal after surgery may increase the risk of hip dislocation (the ball and socket separating), which is one of the leading causes of hip replacement failure. Hip precautions after surgery (no bending greater than 90 degrees, no crossing legs, no excessive rotation) are generally required for this reason. Direct anterior approach (DAA) hip replacement is a minimally invasive surgical technique. This approach involves a 3 to 4 inch incision on the front of the hip that allowsthe joint to be replaced by moving muscles aside along their natural tissue planes, without cutting or detaching any tendons. This approach has been shown in several high quality studies to result in quicker recovery and less post-operative pain. Because the tendons are not detached from the hip during direct anterior hip replacement, hip precautions are not necessary. This allows patients to return to normal daily activities shortly after surgery with a reduced risk of dislocation. This is particularly important for young patients who would like an early return to work or sport. Potential Benefits of Direct Anterior Approach (Minimally Invasive) Total Hip Replacement Regardless of the surgical approach, hip replacement surgery has a success rate approaching 95%. The longevity of a hip replacement has been reported as approximately 90% at 20 year follow-up. The most important factor in terms of technical success involves placing the hip replacement components in the best position. The use of X-ray and the fact that the patient is lying on their back during DAA hip replacement aids the surgeon in getting the implants in the correct positions. The major advantages of direct anterior hip replacement in comparison to traditional approaches include: a more rapid recovery, particularly in the first 3 months following surgery. less pain in the immediate post-operative period – with more likelihood that you will be discharged within 24 hours of your surgery. more normal gait mechanics quicker. a more stable artificial hip without the need for hip precautions. achieving the correct leg-lengths (ie, have both legs the same length after surgery). This is largely due to two reasons, (1) the patient is lying on their back during surgery, so the surgeon is able to accurately compare the lengths of both legs during surgery. Traditional hip replacement surgery requires the patient to be lying on their side, which makes it harder to accurately assess the leg lengths, (2) the use of X-ray during the surgery aids the surgeon in ensuring the components are placed in the correct positions. DAA hip replacement is an option for most patients with severe arthritis of the hip. Patients may not be suitable candidates for the DAA if they have abnormal anatomy (i.e. dysplasia, post-traumatic arthritis) or in cases of morbid obesity (i.e. body mass index greater than 35). Technical Details Direct anterior total hip replacement typically takes between 1 and 2 hours. An incision is made in the front of the thigh over the hip joint, typically 3 cm from the thigh crease (Figure 2). The typical length of an incision is 3 to 4 inches, although this may vary depending on the size of the patient. Figure 2: Red line indicates the position of the skin incision. Once the hip joint has been fully exposed, the arthritic femoral head is removed using surgical instruments. The socket (acetabulum) of the hip joint is then exposed, which involves removing bone spurs and excess tissue within the socket. Hemispherical reamers are then used to remove the damaged cartilage and reshape the arthritic acetabulum to accept the metal acetabulum. A metal artificial acetabulum is then impacted in to the prepared socket. Bone screws may be placed through the metal acetabulum to increase fixation depending a patient’s bone quality. A plastic bearing (highly cross-linked polyethylene) is then impacted and locked into the metal socket. The femur is then prepared. This involves placing a series of progressively larger broaches into the canal of the femur until a tight fit is achieved. A trial head is placed on the final broach, and the hip is reduced. The stability of the hip is assessed at this time throughout a range of motion and leg lengths are measured. If this is felt to be satisfactory the real femoral stem (cemented or uncemented) is implanted into the femur, and a ceramic head is impacted on the neck of the component. X-ray is used throughout, to ensure that the components are placed in the correct position. The wound is then thoroughly washed, and the incision closed with absorbable sutures. The typical length of stay in hospital after direct anterior total hip replacement is at most one night, with some patients able to go home on the day of surgery. There are typically no “hip precautions” (i.e. no bending greater than 90 degrees, no crossing legs, pillow between legs while sleeping) after direct anterior total hip replacement. Because of this, no significant home modifications are typically necessary (e.g., raised toilet seat, bath tub rails, etc.) Patients can return to work when they feel comfortable, although this typically takes 2 weeks or more. Patients can drive when they feel comfortable, but should typically be off opiate medication prior to this. Return to higher level activity (e.g., skiing, tennis, gym activities) is usually restricted for 3 months after surgery. Case Example: A 44 year old male works as a manual labourer, with a 1 year history of worsening right groin pain. He has tried non-surgical treatment (physiotherapy and pain-control medication). His X-rays show moderate-severe right hip osteoarthritis. Figure 3: Right hip Osteoarthritis Following a clinic consultation, and discussion regarding the benefits and risks of surgery, he was listed to undergo a right total hip replacement. He successfully underwent a right “hybrid” total hip replacement via a Direct anterior approach. A hybrid hip replacement describes an uncemented metal cup/socket, and a cemented femoral stem. Prior to surgery his hip was “templated” by the surgeon, in order to help plan what sizes and in which position the implants needed to be placed. He was able to walk 2 hours after surgery and was discharged later that day. X-rays of the hip after the surgery show satisfactory implant positioning. He was off crutches at 7 days post-surgery and back to driving at 2 weeks. Figure 4: Hip replacement after surgery Further Information & Contact: For further information regarding the Direct Anterior Hip Replacement or Traditional Hip Replacement surgery please contact us via: Email:       enquiries@corielortho.com Phone:      07946396194 Website:   www.corielortho.com #coriel #bonehealth #hip #corielorthopaedic #hippain #hipreplacement #bones #arthritis

Paul Haslam Knee Specialist Coriel Orthopaedic Group As a knee surgeon I am particularly pleased that NICE have recommended patients should be offered a partial knee replacement where appropriate. It is estimated that up to 50% of knee replacements could be partial and yet only 10 % are actually performed. This means a large number of patients are having a bigger operation than necessary and never know they could have had a partial knee. The evidence suggests that the functional outcomes of Partial Knee replacement are superior to that of a Total Knee replacement. In addition to this Partial knee replacement is a less invasive procedure leading to a lower chance of developing serious medical complications post operatively. As there is less surgical insult the post-operative recovery is quicker leading to a reduced hospital stay and less pain after the operation. The operation only involves removing the damaged part of the knee and not the ligaments which are retained. This means your knee, following a successful partial replacement, feels almost normal unlike a Total Knee replacement which always feels a bit artificial. This procedure is ideal for patients who want to continue to remain active and play sports such as golf, tennis or skiing. If your pain is mainly located to one part of the joint and x-rays confirm arthritis in one part of the knee only then you may be suitable for a partial knee replacement. Your surgeon should discuss the option of a partial knee replacement with you. If you surgeon doesn’t wish to discuss partial knee replacement it may be worth asking for a second opinion. Case example Partial knee replacement. Mrs A presented with a 3 year history of pain in both knees. She had already had tried all non-operative treatment such as physio, painkillers and steroid injections. Mrs A gave a history of severe pain interfering with all aspects of her life with a recent deterioration leading to night pain and lack of sleep. X-rays showed severe medial compartment osteoarthritis (wear and tear in the inside part of the knee only). Following a thorough examination and discussion of the risks and benefits it was decided to proceed to surgery in the form of a medial unicompartmental knee replacement. This procedure only replaces the damaged inside part of the knee. Mrs A had surgery earlier this year. She was in hospital for only 1 night and recovered quickly. At 2 months she was reviewed and was virtually pain free. As her knee was not keeping her awake at night anymore she was enjoying a good night’s sleep. All her normal activities such as cleaning, walking and shopping were significantly improved after the surgery.